Mortality predictors in complicated patients after anatomical lung resection

Area of Science:

• Thoracic Surgery
• Surgical Quality Improvement
• Patient Outcomes Research

Background:

• Failure to rescue (FTR) quantifies mortality post-complication, serving as a critical surgical quality metric.
• Understanding FTR predictors after anatomical lung resection is essential for enhancing patient survival.

Purpose of the Study:

• To identify risk factors associated with failure to rescue (FTR) in patients undergoing anatomical lung resection.
• To analyze predictors of mortality among patients experiencing major postoperative complications.

Main Methods:

• Retrospective analysis of 2,569 patients undergoing anatomical lung resection (1994-2018).
• Classification of complications (minor/major) using standardized morbidity criteria.
• Stepwise logistic regression and ROC curve analysis to identify FTR predictors.

Main Results:

• 223 patients (8.9%) experienced major complications; 49 (22%) of these could not be rescued.
• Significant FTR predictors included advanced age (OR: 1.07), cerebrovascular accident history (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26).
• The logistic regression model demonstrated good predictive capacity (AUC: 0.82).

Conclusions:

• 22% of patients with major complications after anatomical lung resection did not survive.
• Pneumonectomy and reintervention are the most significant risk factors for failure to rescue.
• Targeted interventions for high-risk factors like pneumonectomy and reoperation may improve FTR rates.